Throughout 2019, states have implemented new benefits for Medicaid because of the rising issues regarding substance abuse, and high prescriptions costs. Overall, 28 states decided to enhance the Medicaid benefits while two decided to restrict.

With 2020 quickly approaching, over 50% of states, elected to lower the cost of prescription costs with Colorado leading the way by importing Canadian drugs instead of American. The states of Nevada and Kansas are requiring prior authorizations for medications, in turn forcing the buyers to search for lower costs or generic options.

Pharmacy Benefit Managers are likewise cracking down on the influx of drug prices by creating more transparency; while rooting out negative practices to contain the opioid epidemic. It has been determined that 4/10 people covered by Medicaid battle with substance abuse.

Policymakers grew lenient for those seeking treatment by allowing Medicaid users to seek substance abuse or mental health treatment at facilities that normally would not be a covered service. Because of this, 43 other states are also allowing for that leeway to be available to policyholders. However, with Medicaid in 2020, benefit restrictions could possibly result in the eliminations of a specific benefit, cap or utilization.

With states and policies constantly changing laws, and forms, it is imperative to stay knowledgeable in these fluctuating areas. Having Inner Circle Billing in your corner, by checking benefits, calling on unpaid claims, and more, will alleviate the paper trail and phone call headache.